INI-CET 2013 — Pediatrics

Q: A toddler presents with a few drops of blood coming out of the rectum. What is the probable diagnosis?

Juvenile rectal polyp. ### Explanation **1. Why Juvenile Rectal Polyp is the Correct Answer:** In the pediatric age group (especially toddlers aged 2–5 years), **Juvenile Polyps** are the most common cause of painless lower gastrointestinal bleeding. These are typically "hamartomatous" (benign) solitary lesions located in the rectosigmoid area. The classic presentation is **painless, bright red streaks of blood** on the surface of the stool or a few drops of blood at the end of defecation. Occasionally, the polyp may prolapse through the anus during straining. **2. Why the Other Options are Incorrect:** * **Adenomatous Polyposis Coli (APC):** This is a premalignant condition characterized by hundreds of polyps. It usually presents in late childhood or adolescence, not typically in a toddler, and is associated with a high risk of malignancy. * **Rectal Ulcer:** Solitary Rectal Ulcer Syndrome (SRUS) is rare in toddlers and is usually associated with chronic straining, mucus discharge, and a feeling of incomplete evacuation. * **Piles (Hemorrhoids):** These are extremely rare in the pediatric population. If present in a child, they are usually secondary to portal hypertension (e.g., cirrhosis or extrahepatic portal vein obstruction). **3. NEET-PG High-Yield Pearls:** * **Most common site:** Rectosigmoid (80-90%). * **Histology:** Hamartomatous (not neoplastic). * **Management:** Colonoscopic snare polypectomy is the treatment of choice. * **Differential Diagnosis:** If the bleeding is associated with pain, consider **Anal Fissure** (the most common cause of *painful* rectal bleeding in children). * **Juvenile Polyposis Syndrome:** Defined by >5 polyps or a family history; unlike solitary polyps, this syndrome carries an increased risk of GI malignancy. [Practice more Pediatrics PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

All Subjects Biochemistry (2)Forensic Medicine (1)Obstetrics and Gynecology (2)Ophthalmology (1)Orthopaedics (1)Pediatrics (2)Pharmacology (2)Surgery (1)

Q1Medium

A 2-day-old premature neonate develops generalized tonic-clonic seizures. What is the investigation done to diagnose the underlying pathology?

Q2Easy

A toddler presents with a few drops of blood coming out of the rectum. What is the probable diagnosis?

INI-CET 2013 - Pediatrics INI-CET Practice Questions and MCQs

Question 1: A 2-day-old premature neonate develops generalized tonic-clonic seizures. What is the investigation done to diagnose the underlying pathology?

A. Transcranial ultrasound (Correct Answer)
B. CT Head
C. MRI brain
D. X-ray

Explanation: **Explanation:** The most common cause of seizures in a **premature neonate** (especially within the first 72 hours of life) is **Intraventricular Hemorrhage (IVH)**. The germinal matrix in preterm babies is highly vascular and fragile, making it susceptible to bleeds due to fluctuations in cerebral blood flow. **Why Transcranial Ultrasound (TUS) is the Correct Choice:** * **Gold Standard for Screening:** TUS is the investigation of choice for diagnosing IVH and Periventricular Leukomalacia (PVL) in neonates. * **Bedside Utility:** It is non-invasive, portable, and can be performed at the bedside in the NICU without moving a hemodynamically unstable premature baby. * **Acoustic Window:** The **Anterior Fontanelle** acts as an excellent acoustic window in neonates, allowing clear visualization of the ventricles and periventricular structures. **Why Other Options are Incorrect:** * **CT Head:** While sensitive for bone and acute hemorrhage, it involves high doses of ionizing radiation, which is avoided in neonates. It also requires transporting the unstable baby to the radiology suite. * **MRI Brain:** Although it provides superior anatomical detail, it is time-consuming, requires sedation, and is technically difficult to perform on a premature neonate on life support. It is usually reserved for stable infants to assess long-term prognosis. * **X-ray:** It is used for detecting skull fractures but has no role in evaluating intracranial pathology like hemorrhage or edema. **Clinical Pearls for NEET-PG:** * **Most common cause of neonatal seizures overall:** Hypoxic-Ischemic Encephalopathy (HIE) — usually seen in term infants. * **Most common cause in Preterm:** Intraventricular Hemorrhage (IVH). * **Screening Protocol:** All neonates born <32 weeks gestation should undergo a screening TUS at 7–14 days of life to rule out IVH. * **Drug of Choice for Neonatal Seizures:** Phenobarbital (First-line).

Question 2: A toddler presents with a few drops of blood coming out of the rectum. What is the probable diagnosis?

A. Juvenile rectal polyp (Correct Answer)
B. Adenomatous Polyposis Coli
C. Rectal ulcer
D. Piles

Explanation: ### Explanation **1. Why Juvenile Rectal Polyp is the Correct Answer:** In the pediatric age group (especially toddlers aged 2–5 years), **Juvenile Polyps** are the most common cause of painless lower gastrointestinal bleeding. These are typically "hamartomatous" (benign) solitary lesions located in the rectosigmoid area. The classic presentation is **painless, bright red streaks of blood** on the surface of the stool or a few drops of blood at the end of defecation. Occasionally, the polyp may prolapse through the anus during straining. **2. Why the Other Options are Incorrect:** * **Adenomatous Polyposis Coli (APC):** This is a premalignant condition characterized by hundreds of polyps. It usually presents in late childhood or adolescence, not typically in a toddler, and is associated with a high risk of malignancy. * **Rectal Ulcer:** Solitary Rectal Ulcer Syndrome (SRUS) is rare in toddlers and is usually associated with chronic straining, mucus discharge, and a feeling of incomplete evacuation. * **Piles (Hemorrhoids):** These are extremely rare in the pediatric population. If present in a child, they are usually secondary to portal hypertension (e.g., cirrhosis or extrahepatic portal vein obstruction). **3. NEET-PG High-Yield Pearls:** * **Most common site:** Rectosigmoid (80-90%). * **Histology:** Hamartomatous (not neoplastic). * **Management:** Colonoscopic snare polypectomy is the treatment of choice. * **Differential Diagnosis:** If the bleeding is associated with pain, consider **Anal Fissure** (the most common cause of *painful* rectal bleeding in children). * **Juvenile Polyposis Syndrome:** Defined by >5 polyps or a family history; unlike solitary polyps, this syndrome carries an increased risk of GI malignancy.